Bipolar illness

Bipoiar Disorders. You must also distinguish the bipolar disorders from MDD. The distinction is particularly important in young adult patients given that nearly 10% of patients with an initial episode of major depression will go on to develop a bipolar illness. The devastating consequences of untreated mania coupled with the possibility that antidepressants may trigger manic episodes in susceptible individu-... 

Phases of Bipolar Illness. The depressive phase of bipolar illness is virtually indistinguishable from unipolar MDD and the diagnostic criteria for a major depressive episode (refer to Table 3.2) are used to diagnose bipolar depression as well. The clinical presentation of bipolar depression often resembles atypical depression, which is characterized by severe fatigue and oversleeping. 

Major Depressive Disorder (MDD). The distinction between MDD and BPAD is most problematic during the earliest episodes of illness and at younger ages of presentation. The first episode of bipolar illness is a depressive one in at least one-third of patients with BPAD. The younger the age of onset of an episode of depression, the greater the likelihood that the disease will progress to BPAD. 

The distinction between major depression and bipolar depression is an important one. Treating a depressed bipolar patient with antidepressant monotherapy (i.e., withont a concomitant mood stabilizer) can propel such a patient into a manic or hypomanic episode. Although it may not be prudent to initiate a mood stabilizer when the evidence for bipolar illness is equivocal, the clinician should be particularly vigilant for the emergence of manic or hypomanic symptoms when starting antidepressant treatment for the first time in a depressed patient. 

Again, the character of the patient s prior episodes, premorbid functioning, and family history all are helpful. By definition, schizophrenia is marked by a 6-month decline in social and occupational functioning that is seldom seen in bipolar illness. In addition, the delusions and hallucinations of schizophrenia are present during periods of normal mood, whereas bipolar patients only experience psychotic symptoms in the context of severe mood disturbance (i.e., mania or depression). 

Between the mood disorders and schizophrenia lies schizoaffective disorder. Taking both unipolar and bipolar forms, schizoaffective disorder is manifested by periods of mood disturbance accompanied by psychotic symptoms that persist even when the mood disturbance has resolved. Schizoaffective disorder typically produces a greater degree of social dysfunction than bipolar illness but less impairment than schizophrenia. 

Depressive Episodes. The emphasis of treatment research in bipolar illness has understandably been on the management of manic and hypomanic phases of these disorders. However, there is clearly room for improvement in the treatment of the depressive phase of BPAD as well. Depression accounts for the majority of BPAD episodes in both men and women, especially the latter. Furthermore, bipolar depression is associated with an increased risk of suicide. 

The diagnosis of mania is made on the basis of clinical history plus a mental state examination. Key features of mania include elevated, expansive or irritable mood accompanied by hyperactivity, pressure of speech, flight of ideas, grandiosity, hyposomnia and distractibility. Such episodes may alternate with severe depression, hence the term "bipolar illness", which is clinically similar to that seen in patients with "unipolar depression". In such cases, the mood can range from sadness to profound melancholia with feelings of guilt, anxiety, apprehension and suicidal ideation accompanied by anhedonia (lack of interest in work, food, sex, etc.). 

Alternate treatments. Mood-stabilization and control of manic or hy-pomanic episodes in some subtypes of bipolar illness may also be achieved with the anticonvulsants valproate and carbamazepine, as well as with calcium channel blockers (e.g., verapamil, nifedipine, nimodipine). Effects are delayed and apparently unrelated to the mechanisms responsible for anticonvulsant and cardiovascular actions, respectively. 

Loranger, A. and Levine, P. (1978) Age at onset of bipolar illness. Arch Gen Psychiatry 35 1345-1348. 

An adopted 15-year-old boy with bipolar illness took to calling the first author Seymour after seeing the musical comedy Little Shop of Horrors. In the drama, the mutating plant becomes increasingly menacing as he demands his rations from Seymour, his... 

Strober, M. and Carlson, G. (1982) Bipolar illness in adolescents with major depression clinical, genetic, and psychopharmacologicpredictors in a three-to four-year prospective follow-up investigation. Arch Gen Psychiatry 39 549-555. 

Leibenluft, E. (1996) Women with bipolar illness clinical and research issues. Am J Psychiatry 153 163-173. 

One of the advances in descriptive diagnosis is the increasingly clear distinction between unipolar and bipolar illnesses. In bipolar illness there is primarily... 

Carbamazepine and Nimodipine in Refractory Bipolar Illness Efficacy and Mechanisms... 

Moreover, for patients who show a wide range of cycle frequencies (as is typical for bipolar illness), this strategy is likely to avoid many of the pitfalls associated with a high rate of placebo response, actually attributable to the natural course of illness and highly predictable on the basis of systematic retrospective and prospective life charting (Post et al. 1988 Squillace et al. 1984). 

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